Aortic regurgitation Flashcards
Definition
Backflow of blood from aorta → LV during diastole (when semi-lunar valves should be shut) due to ineffective coaptation of 3 aortic valve cusps
Causes
- congenital bicuspid aortic valve(should normally be tricuspid)
- rheumatic heart disease
- Marfan’s/Ehlers Danlos syndrome
- infective endocarditis (fever & new regurgitant murmur → think IE as DDx)
- aortic root dilatation
Pathophysiology w/ presentation
Backflow of blood from aorta → LV during diastole causes diastolic pressure to decrease resulting in wide pulse pressure (LARGE difference between systolic & diastolic pressure):
- Quincke’s sign = capillary pulsation in nailbeds
- De Musset’s sign = head nodding with each heartbeat
Blood is pumped from LV → aorta during systole but flows BACKWARDS into LV during diastole due to regurgitant valve. This results in collapsing water hammer pulse/Corrigan’s pulse (rapidly appearing & disappearing carotid pulse)
NB: In aortic stenosis, there is a slow-rising carotid pulse (carotid pulse felt AFTER S2)
Signs
- wide pulse pressure
- Quincke’s sign = capillary pulsation in nailbeds
- De Musset’s sign = head nodding with each heartbeat
- collapsing water hammer pulse/Corrigan’s pulse
MURMURS:
- early diastolic blowing/decrescendo murmur (gets quieter) at right sternal border, 2nd IC
- Austin flint murmur (low pitched mid diastolic rumble) - heard when regurgitation so severe that blood bounces off mitral vale 7 makes a sound
Diagnosis
GS = echocardiogram
CXR- dilated aortic root ( common cause)
ECG- may show LVH
Symptoms of chronic AR
Chronic AR may present more insidiously and patients may remain asymptomatic for many years:
Exertional dyspnoea
Orthopnoea (SOB on lying flat)
Paroxysmal nocturnal dyspnoea
Stable angina can also develop in some patients with severe AR, even in the absence of coronary artery disease. This is due to reduction in diastolic coronary perfusion.
Treatment
- Surgical aortic valve replacement if symptomatic
- IE prophylaxis
